Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Wednesday, October 04, 2006

Had a 20 year old patient lie her way past our triage system last night. She was tired of waiting to be seen so told the triage nurse that she was 3 months pregnant and having heavy vaginal bleeding and abdominal pain. She was evidently quite vocal in triage and given the complaint was brought straight back to be seen.

Per Emergency Medicine philosophy this girl had an ectopic pregnancy until proven otherwise. I took our portable ultrasound machine right into the room after ordering some essentials from nursing. I didn't see anything in the uterus so I was even more suspicious of an ectopic.

Rather urgently we proceeded with the workup but some things did not make sense. Her vital signs were not abnormal, and if she was hemorrhaging it was not evident on cursory exam.

The pregnancy test then came back negative and we ramped down a bit. I figured she had miscarried and delivered the bad news. She wasn't upset. We did a pelvic exam and there was no blood. Curious indeed. She did, however, have a yeast infection and trichomonal vaginitis.

Then her concern turned to how we would treat her pain and the picture changed even further. I told her that I would be happy to treat her pain while she was in the ED but all of a sudden she had to go. She had to have her full treatment for the yeast and the trichomonas because she couldn't afford medicines due to her young child at home and lack of job. No problem, we treated both there.

A few minutes later the nurse came to tell me the patient had pulled out her IV and was bleeding on the floor and would not allow us to bandage the arm. The patient wanted out and wanted answers.

I walked into the room to see blood all over the floor.

Me: "Ma'am you are bleeding all over the floor and creating a health hazard, if you do not sit down and let us bandage your arm I will have to have you escorted off the property."Patient: "It's a hospital, there's supposed to be blood on the floor." Me: "No there's not." Patient: "This hospital sucks, you killed my grandfather."Me: "It's time for you to leave."Patient: "I'm going to sue you and all the nurses... You fucking assholes."Me: "Ma'am, I want you to realize that you had a complete workup here tonight and we have treated every problem we found... Knowing that you do not have insurance and have no money you just got a lot of free stuff by lying. I challenge you to go to the grocery store and demand food for free."

WAIT FOR IT!!!

Patient: "That's exactly what I do... I'm on food stamps."

I mean, can you forgive me for being speechless? I had security escort her off the property.